tci Medicare Compliance & Reimbursement - 2024 Issue Q2

Reader Questions: Understand The Rules On Reinstatement After Exclusion

Question: When an individual is excluded from participating in the Medicare program by the HHS Office of Inspector General (OIG), what is the process for reinstatement? Maryland Subscriber Answer: To be blunt — it’s complicated and it’s based on the parameters of the individual’s exclusion from Medicare and other federal programs. First: You should understand that when a provider is excluded by OIG from federal healthcare programs that it is essentially a ban on payment for services and items rendered to patients. “This payment ban applies to all methods of Federal program reimbursement, whether payment...

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